Chapter 463: Can monkeys have lumbar disc herniation?
"Help him out?"
Zhang Lin is worried that the intern will collapse again.
If something goes wrong, no one can bear the responsibility. It is better to do less than to do more.
The intern shook his head stubbornly and insisted on staying in the operating room. As a surgeon, he will face more exciting scenes in the future, and he must pass this level.
Song Zimo seemed to see himself back then, holding on to the wall of the Moliu Emergency Center, swaying and spinning.
He understood the intern's psychology best at this time. He was afraid of being kicked out of the surgical profession because of this matter. Even if his heart was in a state of chaos, he had to pretend to be nonchalant in order to tell everyone: I can do it!
"Let him stay. Be careful. If you feel uncomfortable, feel free to tell him. It's actually nothing. It's natural to get used to it after seeing too much." Song Zimo encouraged the intern and asked Zhang Lin not to ask him to go out.
Naturally, Zhang Lin did not dare to go against Song Zimo's words. No one could shake Song Zimo's position as the second brother in Corey.
In the past, Zhang Lin and Xiao Wu often dreamed of competing for the position of third brother. Since Xu Zhiliang joined, they have completely given up this idea.
This stuttering is not only a bit paranoid because of hard work, but the key is that the brain is easy to use. Zhang Lin even suspected that this person's mouth couldn't keep up with the speed of his brain, so he stuttered.
The removal of gout nodules is no different from the removal of body surface tumors. It is a first-level surgery, which is the most basic surgery.
However, it is very difficult to maintain normal healing of surgical incisions after surgery. Every detail must be pursued to the extreme, hemostasis must be thorough, and layered sutures must be tight to prevent leakage.
Once leaked, tissue fluid mixed with uric acid crystals will seep out from the gaps in the surgical incision endlessly, causing the incision to eventually fail to heal.
It is impossible to clean out "lime". It is almost everywhere and has penetrated into cartilage, synovium, joint capsule, ligaments, tendons. Almost every tissue around the joint is eroded by it. This erosion has no boundaries. Just remove the clumps of "lime" and rinse repeatedly with a large amount of physiological saline. The white turbid "lime" water will flow from the suction device to the suction tube and into the collection bottle.
The excess skin and fascia are trimmed, the incision is made into a spindle shape, and negative pressure drainage is placed at the surgical site of some huge gouty nodules.
After hard work, more than 40 gout nodules in the body were gradually removed, and the operation was completed.
The patient's appearance has returned to normal and he is no longer a disgusting "monster". Both lower limbs were amputated from the knees. This is the result of years of indulgence in gout.
In the future, if he can insist on taking medicine and control uric acid within the range of 180-300 μmol/L, he can still hope to live a normal life. Some of the uric acid crystals deposited in the body will slowly dissolve.<
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The intern resisted the discomfort and finally stabilized himself. Although his face was ugly, he did not fall down after all. He pretended to be relaxed and stood in the operating room, declaring that he could be a surgeon.
"Fat man, you haven't had gout attacks for a long time, right?"
Zhang Lin asked Fatty Liang when he had some free time.
"I haven't had an attack for a year. I take one tablet of allopurinol every day, just as punctually as washing my face and brushing my teeth. Now my uric acid is stably controlled at over 200."
"My father-in-law also has gout. Do you have any good suggestions on medicine?" Zhang Lin got back to the topic, and Xiaowu also listened attentively.
The lecture time is short, and many things are still not fully understood.
"Do HLA-B*5801 gene screening. If it is negative, allopurinol is the first choice. Don't look at it because it is cheap, thinking that it is cheap but not good. If HLA-B*5801 gene is negative and there are no other contraindications, allopurinol is definitely the best choice.
The best, both in terms of effectiveness and safety, is the best. According to the latest guidelines for gout from the American College of Rheumatology, the recommended first-line drug is allopurinol. In view of the high proportion of HLA-B*5801 gene positivity in the Han population in China,
, does not make first-line recommendations, but if the HLA-B*5801 gene is confirmed to be negative, allopurinol is the first choice." Fatty Liang is unambiguous, he has already studied these drugs badly.
"It makes sense. Elderly people have high blood pressure and so on. It's better to be cautious with febuxostat. When I have time, I'll ask him to do HLA-B*5801 gene monitoring. It costs a few hundred yuan, right? If it's negative, I'll ask him to change it.
Allopurinol." Zhang Lin was relieved after getting a clear opinion.
Xiao Wu also wrote it down, hoping that his father-in-law’s HLA-B*5801 gene test would be negative.
"Cross the bed!" Xu Zhiliang gave the order after taking off his gloves and throwing them into the yellow collection bucket.
As Zhang Lin's superior doctor, Xu Zhiliang is full of authority.
Upon hearing the call from the superior doctor, Zhang Lin immediately cheered up, and together with the trainees and interns, he lifted the patient and transferred the patient from the operating bed to the flat car.
The two amputated limbs were packed in plastic bags and labeled. The cleaners from the operating room came in, completed the handover operation, and sent the short limbs to the pathology department.
"It's best to stay in the pathology department for three months, stand by the examination table in the examination room, eat meat buns, and watch the teacher decompose the liver, stomach, intestines, etc. Then you will pass." Song Zimo patted the intern.
Shoulders.
The intern felt sick, and felt nauseated after hearing this scene. Not to mention eating steamed buns while watching, what a high level of cultivation.
At this time, Yang Ping was answering the phone in the corner, and it was a call from Huang Jiacai from the Demon City.
"The spinal external fixator has been delivered to the Guilin laboratory. We have to make time to go to Guilin. The operation on forty monkeys is estimated to take two days. Fatty, you will go too. Is the anesthesia of the monkeys okay? Xiaowu, you can arrange it.
Let’s go out soon.” After hanging up the phone, Yang Ping arranged the mission to Guilin.
"You will go there after work this Friday? Mr. Song and I will go with you, and Lao Xu and Zhang Lin will guard the ward. Next time, we will switch. We will leave after get off work on Friday and return on Sunday night. I will ask them to prepare their skins a day in advance." Xiao Wu is in charge of external relations. , the outreach activities of these scientific research activities also fall within his scope of work.
The so-called skin preparation is to remove hair from the surgical site and clean the skin.
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The body hair of monkeys is much thicker than that of humans, and skin preparation is also a arduous task. Forty monkeys have to use an electric shaver to remove all the body hair on their backs.
"We have anesthesia equipment and drugs over there. I've shown you the list of equipment and drugs. Do you have any questions?" Xiao Wu asked Fatty Liang.
This is the first time that monkeys are anesthetized, forty at a time.
The dosage of anesthetic can only be adjusted according to the human body and the weight of the monkey. Fatty Liang also consulted his tutor in West China in advance. The tutor is researching a new type of local anesthetic and is currently in the animal experiment stage. He has rich experience in anesthesia after the experiment.
experience.
Scientific research is hard work, especially some basic scientific research. It is very difficult, painful and tiring. Of course, no one is willing to do it if there is no money.
But basic scientific research is the most important, just like the foundation of a building. Without a solid foundation, no matter how beautiful the building is, it will be in vain.
Forty monkeys underwent surgery and were implanted with external fixators. The external fixators were adjusted every day after surgery, including which screws, how many times a day to rotate, and how many scales to rotate at a time. You must be meticulous.
If this is not enough, we must regularly take X-rays, MRI, and CT scans of the monkeys, analyze these image data, take some tissues for microscopic analysis, conduct histoembryological analysis, and dynamically observe the firmness of the external fixator pins.
If a problem occurs during the process, record and analyze the problem.
These tasks will be completed by Ph.D.s sent by the Union Medical College, who have good scientific research qualities.
The patient recovered from anesthesia and returned to the ward. Although his body was covered with gauze, there were no more raised bumps under the gauze.
If all goes well, he can wear the prosthetic leg to train his walking ability in fourteen days.
Back in the ward, Yang Ping had nothing to do. He read the monkey images sent from Guilin. Xiehe's laboratory in Guilin was fully equipped. The quality of these images was very high, including anteroposterior and lateral X-rays of the entire spine and three-dimensional CT reconstruction.
, MRI various sections, the shooting is very standard.
In order to obtain the best imaging pictures, the laboratory staff thought of many ways. They designed an X-ray transparent frame, fixed the monkey on the frame, and then conducted the examination.
These little guys will not let you check them in a polite manner. Even if they are fixed on the shelf, some pictures need to be photographed many times to obtain them.
"You said this monkey X-ray really looks like a child's?"
"Darwin did not say that humans evolved from apes."
"Look, a few physiological curvatures are not too obvious?"
"Yes, why is the physiological curvature not so obvious?"
Zhang Lin and Xiao Wu also gathered around to watch.
"The image data here include not only the 40 monkeys in our experiment, but also a lot of data from their previous experimental monkeys. The physiological curvature of the spine is formed after people walk upright. Although monkeys can stand upright for a short time, they spend most of their time crawling on all fours.
, so the spine does not have typical human physiological curvature." Yang Ping explained to them.
Professor Qin Sihe, an orthopedic expert, once wrote a paper analyzing the formation and correction of deformities from an evolutionary perspective.
"Do you think monkeys will have lumbar disc herniation?" Zhang Lin asked Xiao Wu.
Xu Zhiliang was surprised by Zhang Lin's question: "You're just talking about it. Why did you raise it today? It's so profound."
If you don’t speak in front of the wall every day, why do you stutter again now?
Zhang Lin dared not speak out in anger.
"Look, these are spinal MRIs of elderly monkeys. Look, the three lowest intervertebral discs in humans degenerate the fastest. In old age, they must be dehydrated and show low signal, but monkeys don't seem to have this problem." Yang Ping
I pulled out some information and showed him.
"So---your question--if it hadn't been a mistake, I would have called you Teacher Zhang." Xu Zhiliang really felt that this question was profound.
"How about, after our monograph on retractor is completed, the next topic is to study the difference in lumbar disc degeneration between monkeys and humans?" Xiaowu suggested.
"Actually, from an evolutionary perspective, the human intervertebral disc is a defective product. It has not had time to evolve to adapt to human upright walking, so it is prone to problems." Song Zimo is also thinking about this issue.
Yang Ping partially agrees with this view: "Degeneration is irresistible. Degeneration of the human movement system always starts from the parts where stress is concentrated, such as the lower lumbar spine and knee joints. They are all parts of stress concentration. The anatomy and function must be adapted."
, but unfortunately these areas have not been anatomically strengthened."
To solve clinical problems in medicine, we must start from the basics.